First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Country*

Email*

Home Phone*

Work Phone
x

Cell Phone*

Which pet are you interested in?*
Choose an animal: *Bailey (Home to Home) *Lost Girl (Home to Home) *Maggie (Home to Home) *Sable (Home to Home) Archer Benjamin (Recycle) Boo Litter (Kitten) Buddy Catalina Chica Clementine Cubby (Puppy) Diego Frodo Garth Ginger (Cat) Gordie Grover (Recycle) Harvest Henry Jambo (Ritzy) Jasper (GrandPaws) Koopa (Puppy) Luigi (Puppy) Marigold Millicent Netti Odina Opal Pilgrim and Plymouth (Puppy) Radar (Puppy) Romy & Roxy Rufus Scooter (GrandPaws) Simon Sugar Tarot Tenaya (Puppy) Zara (Puppy)

How long have you thought about adopting a pet?*

Describe the personality and temperament you looking for in a companion.*

Would this be your first rescued pet?

Please tell us about the current pets you have. If none, please enter none*

Are your current pet(s) spayed or neutered?*

Have you ever lost or rehomed a pet?

If yes, Please explain: *

What type of home do you have? *
Choose one: House *with* fenced area House *without* fenced area Apartment

Do you rent or own your home?

Do you have a fenced yard?

What type of fence do you have (wood, Iron, etc.)? Please include the height*

What is your age group?*
Choose one: 17-21 22-30 31-45 46-60 60 plus

How many people reside in your household and what are the ages of your children (if any)?*

Where will your pet sleep?*

How many hours per day will your pet be alone?*

Where will your pet be kept while you are not at home?*

Please enter your Veterinarian's name and phone number. If you do not have one yet, please enter "not yet". *

Describe how you will work on housetraining and teaching basic manners to your pet:*

What exercise and mental stimulation will you be providing for your new pet?*

Have you prepared financially and emotionally regarding potential expenses, such as, emergency care, training, grooming, special diets, etc. to care for this pet for the rest of its life?

Every relationship has a deal breaker. What is the one thing that might make you want to return this pet?*

How did you hear about CVRR?*

Please list at least 1 (one) reference with phone number, who is not a family member. *

By entering my signature and date below, I certify that all my answers are truthful and that I understand that filling out this application does not guarantee placement*